上颈椎损伤合并不连续下颈椎损伤的一期手术治疗  

One.stage operative treatment of upper cervical injury combined with noncontiguous lower cervical fracture

作　　者：王迎松[1] 解京明[1] 张颖[1] 刘路平[1] 鲁宁[1] 陈鸿[1] 

机构地区：[1]昆明医学院第二附属医院骨科,650101

出　　处：《中华创伤骨科杂志》2009年第8期738-741,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨上颈椎损伤合并不连续的下颈椎损伤的临床特点及手术治疗策略。方法2004年5月至2007年8月，对上颈椎损伤合并不连续的下颈椎损伤9例患者进行一期手术治疗。术前神经功能按Frankel评级：A级2例，C级3例，E级4例。其中上颈椎损伤均采用后路于术，经椎弓根寰枢固定融合8例，枕颈固定1例；下颈椎损伤采用后路手术6例，其中以不连续经椎弓根短节段钉棒固定融合4例，2例采用联合上颈椎经椎弓根连续同定；余3例同期行前路减压钛板固定。结果所有患者获得6～48个月（平均13．7个月）随访。术中无一例椎动脉损伤。术后元气管切开或拔管延迟情况，无严重肺部感染、呼吸衰竭、应激性溃疡等并发症发生。患者复值及融合满意，1例2枚下颈椎椎弓根断钉。神经功能：除2例Frankel A级的患者无恢复外，余均为E级。结论上颈椎损伤合并不连续下颈椎损伤导致颈椎极度不稳定，伴有的神经损伤常源于下颈段。一期手术治疗，包括上颈椎后路经椎弓根固定及下颈椎后路经椎弓根或前路减压固定，相对安全且可获得满意疗效。Objective To explore the clinical features and operative strategy of upper cervical injury combined with noncontiguous lower cervical fracture. Methods From May 2004 to August 2007, 9 cases of upper cervical injury combined noncontiguous lower cervical fracture were treated by one-stage operation. Posterior instrumentation was chosen for the upper cervieal injury, including 8 cases of transpedicular screw fixation and fusion on the atlantoaxial vertebra and 1 case of occipital-cervical fixation. Lower cervical fractures were managed by posterior transpedicular screw fixation in 6 cases, including 4 cases of short segmental fixation with noncontiguous screws and 2 cases of long segmental fixation with contiguous upper cervical screws. The other 3 cases were treated by anterior lower cervical decompression and titanic plate fixation. Results They were followed up for an average of 13.7 months （from 6 to 48 months） . No injury to the vertebral artery occurred during operation. After operation, no tracheotomy was needed and intubation was not prolonged. Satisfactory reduction and fusion were obtained, without post-operative complications such as severe pulmonary infection, respiratory failure and stress gastric ulcer. Two lower cervieal pedicle screws were broken. Neural function was not improved in 2 cases of preoperative Frankel A and the Frankel scores were E in the other cases. Conclusions Upper cervical injury combined with noncontiguous lower cervical fracture often leads to the utmost instability of the cervical spine and lower cervical neural dysfunction. Appropriate one-stage operative technique, which includes posterior transpedicular screw fixation in the upper and lower cervical spine or anterior lower cervical decompression, is advocated because of its safety and efficacy.

关 键 词：颈椎 损伤 骨钉 

分 类 号：R686[医药卫生—骨科学]